title: Stressful psychosocial school environment and suicidal ideation in Chinese adolescents.
abstract: OBJECTIVE
  Suicide is one of the leading causes of death during adolescence worldwide. This study, using a sample of Chinese adolescents, examines associations of a stressful psychosocial school environment with suicidal ideation, which were rarely investigated so far.
  
  
  METHODS
  A total of 1,004 Chinese students (468 boys and 536 girls) from Grade 7-12 were recruited into our questionnaire survey. Psychosocial school environment was measured by the effort-reward imbalance questionnaire adapted to the school setting, and suicidal ideation was assessed by a standardized question. Multivariate logistic regression was applied, adjusting odds ratios for age, gender, grade, smoking, alcohol drinking, physical activity, family wealth, and self-rated health.
  
  
  RESULTS
  In school settings, 10.86% students reported suicidal ideation during the last 6 months, which was found to be significantly related to both effort and reward. Remarkably, effort-reward imbalance was associated with elevated risk of suicidal ideation (odds ratio = 1.77, 95% confidence interval = 1.34-2.35).
  
  
  CONCLUSIONS
  This study finds significant associations between a stressful psychosocial school environment in terms of effort-reward imbalance and suicidal ideation in Chinese adolescents. Preventive actions aiming at reducing this imbalance may define a promising approach towards a healthy psychosocial school environment.
authors.affiliation: School of Public Health, Kunming Medical University, Kunming, China.
authors.forename: Li
authors.initials: L
authors.lastname: Shang
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Johannes
authors.initials: J
authors.lastname: Siegrist
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000428:Alcohol Drinking; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012574:Schools; D057566:Self Report; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000208:ethnology* / Q000523:psychology; D013334:Students / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000208:ethnology / Q000523:psychology; D011795:Surveys and Questionnaires